Frenkel Catherine H, Yang Jie, Zhang Mengru, Ferrara Anthony, Telem Dana A, Samara Ghassan J
Department of General Surgery, Stony Brook University Medical Center, Stony Brook, New York.
Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York.
Laryngoscope. 2018 Apr;128(4):847-851. doi: 10.1002/lary.26829. Epub 2017 Aug 22.
Minimally invasive transoral robotic surgery (TORS) is less likely to necessitate gastrostomy tube (GT) following resection of head and neck lesions versus conventional open procedures. However, the incidence of and indications for GT after TORS have not been reported in detail. This study defines the incidence of intra- and postoperative gastrostomy following robotic resection of advanced head and neck disease. It seeks to clarify the relevance of GT after TORS.
Adult patients undergoing TORS and neck dissection from 2008 to 2014 were identified in the New York Statewide Planning and Research Cooperative System all-payer administrative database.
Demographic data and timing of GT in relation to surgery were recorded. Emergency department (ED) visits and inpatient readmissions were compared with multivariable logistic analysis.
Of the 441 included patients, immediate, delayed, and total GT incidence within the first postoperative year was 9.5%, 11.6%, and 21.1%, respectively. Gastrostomy tube complications resulted in 4.5% of 30-day ED visits, 3.3% of 30-day readmissions, and 3.5% of 90-day readmissions. Thirty-nine percent of 90-day readmissions were linked to poor postoperative oral intake. Delayed GT status was associated with an increase in 30-day ED visits, and 30- or 90-day readmissions attributable to poor oral intake (P = 0.10, P < 0.0001, 0.002, respectively).
Even in the era of minimally invasive TORS, impaired oral intake is a significant postoperative burden to head and neck cancer patients with advanced disease. Attention to patient risk factors combined with a complicated hospital course may identify patients benefiting from early GT.
2c. Laryngoscope, 128:847-851, 2018.
与传统开放手术相比，微创经口机器人手术（TORS）在切除头颈部病变后较少需要胃造瘘管（GT）。然而，TORS术后GT的发生率及适应证尚未有详细报道。本研究确定了机器人切除晚期头颈部疾病后术中及术后胃造瘘的发生率。旨在阐明TORS术后GT的相关性。
在纽约全州规划与研究合作系统的全付费者管理数据库中识别出2008年至2014年接受TORS和颈部清扫术的成年患者。
记录人口统计学数据以及GT与手术相关的时间。通过多变量逻辑分析比较急诊科（ED）就诊和住院再入院情况。
在纳入的441例患者中，术后第一年内即时、延迟和总的GT发生率分别为9.5%、11.6%和21.1%。胃造瘘管并发症导致30天内ED就诊的4.5%、30天内再入院的3.3%以及90天内再入院的3.5%。90天内再入院的39%与术后经口摄入量少有关。延迟GT状态与30天内ED就诊增加以及因经口摄入量少导致的30天或90天内再入院有关（分别为P = 0.10、P < 0.0001、0.002）。
即使在微创TORS时代，经口摄入量受损仍是晚期头颈部癌症患者术后的一项重大负担。关注患者风险因素并结合复杂的住院过程可能有助于识别能从早期GT中获益的患者。
2c。《喉镜》，2018年，第128卷，第847 - 第851页
